1174628143 NPI number — DR. JOHN D ILARIO M.D.

Table of content: DR. JOHN D ILARIO M.D. (NPI 1174628143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174628143 NPI number — DR. JOHN D ILARIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILARIO
Provider First Name:
JOHN
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174628143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 WESTCHESTER AVE FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PURCHASE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10577-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-607-5730
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1084 N BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-848-8640
Provider Business Practice Location Address Fax Number:
914-848-8641
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  107284 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000018230 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 107284 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2143414 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4213831 . This is a "AETNA PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12478 . This is a "HUDSON HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C1337 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00188803 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1000017418 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0039800 . This is a "GHI PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 960142 . This is a "EMPIRE BCBS OF NY YONKERS AVE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 160046003 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 960141 . This is a "EMPIRE BCBS OF NY BROADWAY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: WP220 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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